Standing Committee E

[Sir David Madel in the Chair]

Health and Social Care Bill

Clause 7 - Functions of Overview and Scrutiny Committees

Paul Burstow: I beg to move amendment No. 44, in page 6, line 20, at end insert—
`( ) as to the commissioning of independent advocacy services and requirements placed on any officer of a local NHS body or other specified body to assist the advocacy service in discharging its duties,'.

David Madel: With this it will be convenient to take the following: Amendment No. 237 in clause 9, page 8, line 8, at end add—
`(4) It is the duty of every body to which this section applies to commission independent advocacy services to support any formal complaints made against that body and to support patients' use and access to services provided by, or under arrangements made by, that body.'.
 New clause 5—Patient Advocacy and Liaison Services— 
`.—(1) The Secretary of State shall make regulations requiring all NHS trusts and Primary Care trusts to set up services to be known as Patient Advocacy and Liaison Services (PALS) and making provision for such services, including the establishment of links with Patients' Forums. 
 (2) It is the duty of each PALS to provide advocacy services to patients both in relation to everyday use of services provided by, or under arrangements made by, the relevant trust and in relation to complaints, including formal complaints, about the provision of such services. 
 (3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations.'.

Paul Burstow: Welcome to the Chair of this Standing Committee, Sir David. We are having very interesting deliberations. I want briefly to address this group of amendments, which deals with two related issues. The first is independent advocacy, which we spent some time discussing in the broader debate that we had this morning. We now come to the more specific details of how we are to secure that independent advocacy. The second is the further examination of the proposals for the patient advocacy and liaison services staff, which are not in the Bill but were referred to in the Government's explanatory notes.
 Amendments Nos. 44 and 237 deal with the question of advocacy and would enshrine in the Bill the Government's commitment to providing the funds and the necessary regulations to ensure that independent advocacy services are established. They would also provide that whoever is responsible for funding those services--the pay and the rations--be it a local authority or a health authority or some other potential commissioner of these services, it is able to ensure that the advocacy service can operate effectively on behalf of patients. It should ensure that any NHS body it deals with understands that it should signpost patients to the advocacy service when that is appropriate, and should set out when that would be appropriate so that there is no doubt about that. It should also ensure that the various agencies within the trusts are willing and able to co-operate with the advocacy service. 
 New clause 5 also deals with the role of patient advocacy and liaison services. Even at this late stage, we should reconsider the name of these services, especially as the Government have not been persuaded of the merits of including in the Bill provisions governing the operation of this particular function within trusts. This morning we were told that many people in hospital who want to complain are not aware of the existence of community health councils. I fear that confusion will be sown by calling it an advocacy service, because, on any standard definition of that role, the post will not actually operate as an advocate. We are in danger of causing confusion. This is not merely a point of semantics. People will be confused when they consider the range of bodies that they are asked to deal with when they have problems with the NHS. We need to be careful about the language we use so that we minimise that confusion. I hope the Minister will comment on that, because we currently have two bodies that use the term advocacy in very different ways. 
 New clause 5 seeks clarity on the boundaries between PALS, the independent advocates and the patients forums. It would enable the Secretary of State to use regulation-making powers, and would at the very least allow further scrutiny, through secondary legislation, of the details of how PALS will be rolled out and operated on the ground. That is why we tabled these amendments. We do not want to diminish the value of such services within trusts—that has not been our argument—but this important role should have a statutory basis. That is what new clause 5 asks for, but if the Government cannot accept the amendments, I hope that they will be willing to table similar amendments. 
 How soon will the Government make proposals on advocacy services to guarantee that they are secured? How do they intend to secure the funding arrangements? Will there be new funds? Are funds already included in the comprehensive spending review, or will additional moneys be made available to fund the development of a comprehensive network of advocacy services? On the face of it, the comprehensive spending review does not contain the wherewithal to fund that significant expansion throughout the country. 
 I look forward to the Minister's response, and I hope that it will be positive.

John Denham: I, too, welcome you to the Committee, Sir David. We have had some productive sittings, and I am sure that that will continue under your chairmanship.
 It is an interesting group of amendments; they would be contradictory if we were to accept them all, but they allow us to explore the issues involved. The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether PALS should be a statutory body. We envisage the service being one of the functions of trusts, and such functions—the specific services provided by trusts, such as running out-patients clinics or doing operations—are not provided for in primary legislation. It would therefore be rather odd to include PALS in the Bill. The hon. Gentleman will have noticed, however, that under later amendments we shall provide the means by which a failing PALS or one that had been neutered by management could be taken out of the trust. If those later amendments are accepted, we shall, in a roundabout way, have provided some protection of the advocacy and liaison service. 
 We disagree with the hon. Gentleman on independent advocacy to support patients through the formal complaints procedure. We have been persuaded by CHCs and others that that formal role needs to be separate from the advocacy and liaison service role. New clause 5 would seem to put PALS in charge, but we would not want that. Nor do I agree that the independent advocacy service should be provided by the local authority scrutiny committee, but where it should go is something for further discussion. There are two possible models of providing the independent advocacy service. It could either be commissioned by the health authority—the obvious choice—or by the local authority. In turn, the local authority could be either the commissioner of the service or a provider of the service, commissioning the service from itself. 
 At this stage, it is better to allow further discussion and even some local flexibility. Funds will clearly be needed. We may take a similar route to that taken for CHCs, which is to use the regional health authorities for that purpose. There are clear attractions in locating the advocacy service in a local authority, particularly if, as we suggest in the explanatory document, the authority were to provide the secretariat for the patients forum in the area. That would mean a concentration of staff; they would be working for the same service in the same location. It is better that the Bill is not too prescriptive. Discussions are continuing with the health service, the Local Government Association, CHCs and other patient groups. A clear line suggests itself, and we want to discuss it in more detail. 
 It has been a brief debate, but I hope that I have responded to the major points raised by the hon. Member for Sutton and Cheam.

Paul Burstow: I am grateful to the Minister for having clarified one or two matters. In return, I shall clarify the thinking behind new clause 5. It is not intended to substitute powers for the provision of the independent advocacy service, and the Minister is right that it would be inconsistent for the other two amendments to be read alongside it.
 The Bill should place a specific obligation on the Secretary of State to ensure that advocacy services are commissioned, even if we are not specific about the commissioner. Will the Minister suggest whether there would still be an opportunity for a legislative amendment if consultation on the matter were concluded before the conclusion of the passage of the Bill? 
 Although we may come back to these issues later, I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn.

Paul Burstow: I beg to move amendment No. 45, in page 6, line 20, at end insert—
`( ) as to the composition of the committee so as to include representatives of the voluntary sector and the Patients' Forum'.

David Madel: With this it will be convenient to take the following amendments: No. 25, in page 6, line 33, at end insert—
`(g) as to information which the committee shall make available to Patients' Forums.'.
 No. 75, in page 6, line 33, at end insert— 
`(g) requiring the committee to liaise with the Patients' Forums on matters of concern raised by the Patients' Forums,
(h) as to matters allowing the committee to set up local enquiries with the power to call for evidence, 
 (i) as to matters allowing the committee to refer matters of concern to NICE, CHI, the Audit Commission and the Secretary of State.'.

Paul Burstow: These amendments are about representation and how we ensure that the overview and scrutiny committees are not made up only of local councillors, important though their contribution to the scrutiny process will be. As with other local committees, the scrutiny committee will deliberate on the interests and expertise of others. In the context of the amendments, I am thinking of the role of the voluntary sector in our communities, and also the scrutiny role of those serving on patients forums—or, as we would prefer, a patients forum for each locality. We need to establish firm links between the role of the overview and scrutiny committees and the role of patients forums, so that we can avoid issues falling between stools. An overlap of membership would go some way towards addressing that concern.
 The amendments deal with the type of information that will be available to patients forums. We want to establish clearly in the Bill obligations on the exchange of information between the overview and scrutiny committees and patients forums. I am sure that the Minister will tell us that that will happen anyway, but we have been told by Labour Members that the CHCs have not performed as well as they might, despite the fact that the regulations that establish them are detailed. All that I ask is for a reference point in the Bill, to make the fact that communication should take place between the two bodies clear and indisputable. The bodies are important to the establishment of the Government's framework for the new overview and complaint systems in the NHS.

Desmond Swayne: I add my congratulations to you, Sir David, on taking the Chair. It is always a tremendous pleasure to address the Chair, especially when you occupy it.
 I understand the rationale behind the amendments tabled by the hon. Member for Sutton and Cheam. I share his anxiety about creating an interlinking network between the patient advocacy and liaison services and the scrutiny function. That is important, especially as those who participate in the PALS will have had experience of complaint handling, and will have powers of inspection. An avenue for the passage of information should be opened up. 
 My concern is about the nature of the membership of the overview and scrutiny committees. I have always regarded such committees as an opportunity to redress a perceived—and, I think, real—lack of democratic accountability in the health service. It is therefore proper that the members of those committees should be elected councillors. By introducing co-opted members as full members of such committees, would we weaken that principle? That is my only concern with the amendment.

John Denham: The first two amendments seek to prescribe, through the Bill and through regulations, the relationship between the patient forums and the overview and scrutiny committees, in a way that goes beyond what is desirable or necessary. We understand the need for patients forums and scrutiny committees to work together. Although that is desirable, the bodies have different roles, and they must exist separately. The amendments would go too far in trying to merge their functions, at least at the edges. Patients forums are about bringing patients' views into the NHS, for every trust. The scrutiny committees are about scrutinising the way in which the NHS is developing and delivering its services locally.
 There will, in practice, be plenty of scope for co-operation between the two bodies. Under the local government legislation enacted last year, scrutiny committees already have the power to co-opt and involve people who are not elected councillors as members of the committee. I agree with the hon. Member for New Forest, West (Mr. Swayne) that that should be under the control and in the gift of the democratically elected councillors. It should not be set out in regulation by central Government that scrutiny committees should co-opt a certain number of such people under certain circumstances. It is better for that to remain the prerogative of the committees. 
 Similarly, it will be useful for pertinent information to flow and be shared between patients forums and scrutiny committees, not least to enable them to understand each other's perspective on local issues. However, it is overly bureaucratic to set out in regulations exactly what information should be passed around. There is nothing in our proposals that prevents scrutiny committees and patients forums from sharing relevant information. I hope the hon. Member for Sutton and Cheam accepts that we are not trying to block the co-operation that he seeks, but that there is a difference between us over whether such co-operation should be prescribed by the legislation. 
 Amendment No. 75 raises different issues. The scrutiny committees would be able to refer matters to the Commission for Health Improvement, to the National Institute for Clinical Excellence, or to the Audit Commission. The Commission for Health Improvement will often be the most appropriate body to which to refer issues that are raised in the course of scrutiny, because of its powers to investigate the management, the provision and the quality of local health services. Under existing legislation, the CHI can accept referrals from any individual or body, so the provision is already there for scrutiny committees to make such referrals. A committee would not have to limit itself. It could make its concerns known to the Secretary of State, or to regional offices of the health service. 
 I have more difficulty with the idea of scrutiny committees establishing local inquiries. The hon. Member for Sutton and Cheam did not say a great deal about that in his opening remarks, and I may have misinterpreted him, but we could be in great danger if we were to have a plethora of bodies that were all able to set up independent inquiries into the same incident or series of events. Normally, inquiries in the health service are set up under health service legislation. They may be less formal, and be set up by the organisation itself—the health authority or the regional office on behalf of the Secretary of State. More formally, they may be set up under, for example, section 84 of the 1977 Act, which is the legislation under which the Bristol inquiry was established. Under exceptional circumstances, powers under the Tribunals of Inquiry (Evidence) Act 1921 may be used, as in the case of the inquiry into Harold Shipman. The CHI may also set up an independent inquiry. 
 We do not need to add another formal system for establishing inquiries into that field of provision. Clearly, in the broader sense of the word, scrutiny committees will inquire into various issues. They will be able to call in chief executives, ask about the accident and emergency departments or the provision of maternity services or whatever issue they choose to scrutinise. They will hold inquiries, rather like Select Committees. However, that is not the same as looking into a formal clinical incident, such as happened in Bristol.

Paul Burstow: I am grateful to the Minister for commenting on that point. Certainly the intention behind the amendment is not to set up a second-guessing exercise around such important inquiries, but perhaps to consider issues of reconfiguration and performance. The Minister said that the Bill should not be too prescriptive about the provision of information. Does he accept that the Bill already contains considerable powers to stipulate what information can and cannot be provided by NHS bodies? Why cannot the Secretary of State stipulate what information should be exchanged between patients forums and overview and scrutiny committees?

John Denham: The provisions on information are to ensure that the legislation reflects the safeguards that are provided in the wider operation of scrutiny committees in looking into local government services. They do not govern the flow of information from one body to another. I suspect that we are at one in wanting to see a useful flow of information between the two bodies. That would be eased considerably if we were to combine the secretariat and support for these functions within, say, a local authority.

Paul Burstow: We welcome the proposition in the briefing notes that local authorities should provide the secretariat. Local authorities may well provide the glue in the new system that pulls it all together. If so, that will be very welcome. However, it would be strange if there were Chinese walls between the different institutions when it came to information exchange. We want to ensure that that does not happen.
 The Minister usefully referred to the danger of a plethora of bodies undertaking inquiries. I share that concern, and may come back to that point. I welcome the fact that the Minister is seeking plenty of opportunities for co-operation between these bodies. Therefore, I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn.

Desmond Swayne: I beg to move amendment No. 243, in
 page 6, line 20, at end insert— 
`( ) as to matters relating to co-operation between the health service in the authority's area and providers of personal social services in that area'.
 Amendment No. 243 need not detain us long because all it does is to add an item about which regulations may be made concerning the scrutiny committees. It strikes me as an obvious that co-operation between the health service and providers of personal social services should be included. I cannot imagine any circumstances in which a scrutiny committee would not consider that issue. There is a long history of institutional barriers between the NHS and the providers of personal social services, although much progress has been made in recent years in breaking down those barriers and moving forward to a better agenda. The creation of this new scrutiny function provides yet another institutional opportunity by which to pursue that agenda. As we are here to help, I thought we should place it in the Bill.

John Denham: The hon. Member for New Forest, West is right about the need to be able to scrutinise both health and social services. I am advised that this is not a necessary provision, and that the combination of the measures that we are taking in this Bill and those that are already in the Local Government Act 2000 make it possible for scrutiny committees to undertake that function.

Desmond Swayne: In view of what the Minister says, I accept his assurances and beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

John Denham: I beg to move amendment No. 187 in
 page 6, line 32, leave out `or other specified body'. 
 This is a minor amendment concerning the arrangements that the scrutiny committee will make with the NHS for its scrutiny. The Secretary of State is permitted under the terms of this clause to make regulations concerning the requirement for NHS officers to appear before the scrutiny committee. It is envisaged, for example, that the scrutiny committee may call the chief executive of the trust to account twice a year. The scrutiny committee will assess, among other things, how well the trust has carried out its duties to consult and involve the public under clause 9. It is not necessary for the Secretary of State to be able to regulate for any ``other specified body'' to appear before the scrutiny committee. It should be just involve the health service, so the amendment removes the reference to ``other specified body''.

Desmond Swayne: I was intrigued about who else the Government thought might have been summoned when they drafted the clause, given that they have now changed their minds?

John Denham: Ours is not to speculate on the workings of the minds of parliamentary counsel. Various suggestions are made to Ministers to be helpful, but after close scrutiny it is sometimes possible to identify helpful things that one should not take a power to do.
 Amendment agreed to.

Desmond Swayne: I beg to move amendment No. 244, in
 page 6, line 33, at end add-- 
`( ) requiring any member of an overview and scrutiny committee who is also a member of a Health Authority, NHS Trust or Primary Care Trust not to take part in the discharge by the Committee of the functions described in subsection (1) above.'.
 It strikes me that there is an opportunity to discuss at some length Dame Fritchie's report on appointments in the NHS, but given the lateness of the hour, and knowing that we only have until 10 o'clock, I shall pass up that opportunity. 
 There has been a sharp increase in the number of local government representatives, to which Dame Fritchie's report bears testimony. I commend that report to all members of the Committee. NHS trusts, PCTs and health authority boards will inevitably have a not insignificant number of councillors of a political persuasion. It will make nonsense of the scrutiny function if members of local authority scrutiny committees scrutinise the responsibilities that they have discharged as board members. The amendment is entirely proper, as it would require them not to do so, and would exclude such conflicts of interest from the Bill.

John Denham: I am happy to accept and to echo the sentiment behind the amendment.

Peter Brand: I am grateful to the Minister, and I think he is sensible to accept the spirit behind this amendment. Would he go a little further and say something about members of social services committees and those members of the executive of local authorities who are responsible for social services matters? They, too, should not be members of this scrutiny committee, as with joint commissioning the same conflict of interest may well arise.

John Denham: The hon. Gentleman makes a helpful point. A conflict of interest may arise in a number of different circumstances with the operation of overview and scrutiny committees. The Department for the Environment, Transport and the Regions is working with the Local Government Association to produce a code of conduct for overview and scrutiny committees across a range of possible conflicts of interest, including financial conflicts of interest and conflicts of responsibility. We are working together on that code.
 I understand that a draft code of conduct will be published within the next two weeks; it will certainly be available before the full parliamentary scrutiny of the Bill has been completed. It is worth saying that executive members on local authorities cannot be members of overview and scrutiny committees, but the hon. Member for New Forest, West makes a fair point about councillors who may also be board members.

Desmond Swayne: When the Minister said that he accepted it, I thought for a moment that he meant the amendment and not merely the sentiment behind it. In view of what he has said about the imminence of the code of conduct, I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

John Denham: I beg to move amendment No. 188, in page 6, line 34, leave out subsection (4).

David Madel: With this it will be convenient to discuss the following: Amendment No. 227, in page 6, line 37, at end insert—
 `(4A) Regulations under this section may also provide for functions under section 21(2)(f) of the Local Government Act 2000 to be performed under joint arrangements, to be determined locally, between a county council and any or all districts within the county council area.'. 
 Government new clause 9— Joint overview and scrutiny committees etc.—

John Denham: We flagged up this group of amendments and the Government new clause before lunch. We are trying to set up an improved joint scrutiny committee structure that allows flexibility for local authorities and for the NHS. Amendment No. 188 and Government new clause 9 allow for a range of options from which local authorities may choose the most appropriate format.
 The new clause allows two or more authorities, which can include district councils, to form themselves into a single overview and scrutiny committee to scrutinise health organisations. If a district council joins with a county council, the scrutiny is the county council's responsibility; the county council therefore remains in the lead. 
 The new clause provides for two or more authorities whose scrutiny committees are responsible for scrutinising the NHS to give the lead to one authority so that it exercises the others' functions in relation to health scrutiny. Two or three local authorities could agree that one of them would exercise the scrutiny function. The clause also provides for a county council and a district council to arrange for the district to undertake the county council's responsibility of scrutinising health services in the district. That is likely to happen when a primary care trust is being reviewed. The clause provides for a county council to co-opt one or more district councils' OSC members on to its own OSC; and the county council may also co-opt district council OSC members if the county is part of a joint scheme with another OSC. 
 The aim is to allow flexibility and to enable the building of local scrutiny models that are fit for the purpose. The clause specifies that regulations relating to the joint arrangements will set out the circumstances and conditions under which joint schemes can be established. It should be noted that district council involvement in the joint scheme arrangements will be set out in regulations. 
 As I said earlier, the lead will always be with local social services authorities, and regulations and directions may also provide for those circumstances in which authorities will be required to put joint scheme arrangements in place. The regulations that relate to the normal arrangements for scrutiny and review of the NHS by OSCs will also apply to the scrutiny and review of the NHS when joint schemes are in operation. 
 New clause 9 provides real flexibility for local authorities when undertaking 
 their health scrutiny role. It will result in the most effective use of resources, and when appropriate district council involvement can be included. The Committee will know that that has been a particular concern to the Local Government Association and will have noted that the LGA has warmly welcomed new clause 9 in its briefing note.

Desmond Swayne: I shall not go back over ground that was covered this morning on amendment No. 245. However, I had hoped that the Minister would say rather more than that the regulations will cover the operation of the overview and scrutiny committees. I seek some understanding of how the Minister sees the system operating. Many people, including myself, are not clear about how it will operate and how the local authorities will divide up the patch between them.
 We know of the correspondence from Epping Forest district council, but I shall quote the Democratic Health Network, as it is time that it had a second outing after its tour de force last week, which provoked a response of stony silence from Labour Members. It states: 
``one health scrutiny area might include a Health Authority, several PCTs, a Care Trust and several acute Trusts as well as services provided under partnership arrangements''. 
If, as a minimum, we expect the scrutiny committee to deal with the chief executive twice a year, its burden and work load may be significant. I would like to follow the Minister's concept of how the overlapping local authority responsibilities knit together. Rather than simply being told that regulations will provide that the process works, I want an understanding of how it will work.

Peter Brand: Clearly, our amendment No. 227 is in the spirit of Government new clause 9. I recognise that the new clause is essential in areas not blessed with coterminosity, such as the Isle of Wight.
 Will the Minister explain how the joint committees will address the democratic deficit that he says is behind some of the changes? Committees will be composed of democratically elected individuals who may be democratically accountable as individuals. However, I cannot see that a joint body of perhaps four or five local authorities, and a local authority that perhaps has to service two or three joint authorities, creates a direct link between a democratic process and the scrutiny that is so important to the community. We will not end up with anything more directly accountable than a CHC, as it has elected members. 
 The nearest pattern that I could think of was the local land drainage committees, one of which I was a member of for some years. They travel around the country and see splendid things, but have no influence over anything. I am concerned that we will set up a mechanism to produce window dressing that is not accountable for the work that it does. I would like the Minister to explore what would happen on a joint committee, as opposed to a lead authority, if members of it or the sub-sets of the lead authority committee were of completely different political flavours, persuasions and backgrounds.

John Denham: As a former member of a land drainage committee, I can bring relevant knowledge to bear on the subject. I recall that the committee often involved an extremely good lunch, and that a suspiciously large number of farmers who owned low-lying land seemed to be co-opted on to it.
 I understand the points that both hon. Members raise. Guidance will clearly be needed about how local authorities come together, although we would want to leave some flexibility for people to work matters out locally. I shall take the example of the Southampton and South West Hampshire health authority, which I share with the hon. Member for New Forest, West. It is clear that there would be cases where there would be a desire to scrutinise the overall strategy—the health improvement plan and so on—of the health authority. At the very least that would require co-operation between Southampton city council, which is a unitary authority, and Hampshire county council. Other areas, such as that of the operation of primary care trusts in Southampton, might be solely a matter for the unitary authority in Southampton, because it happens in its area. Some flexibility in arrangements on topics is likely to be necessary, over time. It would not be possible or desirable for us to prescribe, from the centre, exactly what arrangements should be made in each case. 
 I do not agree with the hon. Member for Isle of Wight (Dr. Brand) that because two authorities come together the democratic element is lost. After all, both organisations are democratic, and would need, within the guidance, to agree on the way in which they brought their functions together. Such co-operation would provide a sensible and practical way for the scrutiny committees to operate at local level. One would expect reports to be made not just to the NHS body that is being scrutinised, but to the host local authority, to be considered by the wider body of council members.

Peter Brand: On a practical point, would it be possible for the joint authority to publish minority reports, or would that depend on the report going back to one of the host authorities, which would then evaluate it. I doubt whether there can be a mechanism for doing that, as it would be very difficult. In the Minister's own patch, where Eastleigh and Romsey share health services, there are two distinct views of how those services should be delivered by the local authorities.

John Denham: First, minority reports are, and would be, possible under the scrutiny committee approach. During the scrutiny process, one would expect different local perspectives to come through from the councillors who were involved. The process is not a way of expressing the view of the local authority per se. It is a similar scrutiny process to those that apply to other local authority services. I do not see any major difficulty in local authorities sensibly co-operating with each other, and being able to explore, through the scrutiny process, all the relevant issues. Surely that is the most important point. The LGA was keen to make a similar provision for district councils for fear that a particular local perspective, or view of a topic, would otherwise be lost. With the new clause, we are ensuring that such perspectives are not lost.

Peter Brand: I fully agree with the latter part of the Minister's reply, but he also implied that we were talking about pure scrutiny. I thought that the new body would take over the strategic planning commentary, which was such an important part of the role of CHCs. Clearly, such a commentary is not just a matter of scrutinising what is currently happening, but of monitoring the direction in which local health provision is moving. That can be very different for different authorities—some may gain and some may lose.

John Denham: The hon. Gentleman is right, and I had included, in my mind, the scrutinising of those major reconfigurations within ``scrutiny,'' so we agree on that. The hon. Gentleman seems to be concerned that the Government would somehow try to run the system so that geographically distinct or minority views were corralled into a wider body and thereby suppressed. I understand his concern. We must deal with that in the guidance on when scrutiny committees can come together to share their functions. I acknowledge his point, but that is something for which we can make proper provision.
 Amendment agreed to. 
 Question proposed, That the clause, as amended, stand part of the Bill.

Desmond Swayne: Although our debates have covered most aspects of the clause, it is still not clear how local authorities will find the resources to discharge the responsibilities that we are placing on them. We have been given no inkling. Equally, our debates on the amendments have made it clear that those who will be discharging the scrutiny function will not have the benefit of having handled complaints or of having been inspected, which are two vital elements of scrutiny. In my view, those three counts place a large question mark over the fundamental nature of the clause.

John Denham: There is some danger of going over old ground, but it is the Government's view that enabling local government to scrutinise the health service is a step forward because it will allow them start dealing with the democratic deficit in the NHS. It is inevitable that the pattern of health provision will not map directly on to local authority provision. We therefore need to make flexible arrangements to allow that to happen effectively. As scrutiny committees develop their role, they will gain great expertise, prove to be effective and, for the first time, bring a democratically elected local authority voice into shaping health services.
 I acknowledge, as I have throughout, that it will be useful for the scrutiny committee to be informed by a range of information provided by the NHS, patients' organisations in general and patients forums, which undertake the inspections. We have set out in the explanatory notes a number of arrangements to ensure that it happens. I believe that it will be an informed process of scrutiny. 
 Question put and agreed to. 
 Clause 7, as amended, ordered to stand part of the Bill.

Clause 8 - Overview and Scrutiny Committees: Exempt Information

Question proposed, That the clause stand part of the Bill.

Paul Burstow: I have a question on the Government's thinking about the difference in operation between NHS bodies, which are governed by the access arrangements made under 1960s legislation on access to public bodies, and local authorities, which are governed by the Local Government Act 1972. Can the Minister tell us a little more about how, through regulations, he can ensure that a trust cannot decide that it would be embarrassed to provide information that was not exempted under the Local Government Act that might nevertheless be exempt under the 1960s legislation? How can we ensure that local authorities, with their new powers of overview and scrutiny, can obtain all the necessary information, including information that trusts might not want published under the 1960s legislation but which they would have to publish if they were covered by the Local Government Act?

Desmond Swayne: I echo what the hon. Gentleman said, but I would go further. I believe that we have the chance to review the two sets of rules under which the two bodies will operate. If the scrutiny committees operate under one set of confidentiality rules and health authorities and the NHS enjoy a much wider discretion to withhold information, a measure of suspicion is bound to grow between two bodies that we want to work to a large extent in partnership.
 It strikes me that the Bill may provide an opportunity for the Government to review the issue to see whether there is a means of introducing proposals for a common set of standards for confidentiality. I suspect that there will always be the temptation, and it might be a quite legitimate concern for NHS bodies, that information that they might regard as confidential, would not be regarded as confidential within the rather narrower terms under which local government bodies operate once they had been handed over to the scrutiny committee. That might result in a reinforcing of what might be an administrative inertia to hand over information in the first place.

Peter Brand: I am concerned about what information the scrutiny committee may have and what sort of paperwork there may be. A very relevant question was asked this morning by the hon. Member for Woodspring (Dr. Fox) in relation to clause 15 on who would become the custodian of files and information held by community health councils. The Minister did not answer at the time. Perhaps he could now let us know where that information will go? It will obviously include a mix of personal and clinical information as well as more strategic information.

John Denham: The clause is essentially about the openness of the business of the scrutiny committee. Under clause 7, the Secretary of State can require the NHS to provide information to the scrutiny committee. So we will use that route to ensure that the necessary information is made available to the scrutiny committee.
 The Local Government Act 2000 provided that meetings of the overview and scrutiny committee must be held in public. The Local Government Act 1972 provided for two exceptions to that general obligation: first, where certain confidential information may be disclosed and secondly where the scrutiny committee agrees by resolution of the committee or council that certain exempt information may be disclosed. 
 Section 12A of the Local Government Act 2000 sets out the categories of exempt information, such as information relating to a particular employee of the local authority or to a person receiving services from the authority. Where a scrutiny committee is discussing NHS matters, for example where it has asked the chief executive of the local health authority to attend, it is possible that the committee may discuss matters that would lead to the disclosure of information relating to the NHS that would not be appropriate to disclose to the public at large, such as information relating to personnel. The function of clause 8 in combination with schedule 1 to the Bill sets out the information that local authorities do not have to disclose at a public meeting of the scrutiny committee. 
 Where the restrictions on NHS bodies that are governed by the Public Bodies (Admission to Meetings) Act 1960 are more restrictive than the provisions that now apply to overview and scrutiny committees, we have modelled our approach on the approach in the Local Government Act 2000 rather than on the 1960 Act. The provision for public access to meetings and documents of NHS bodies is more restrictive than is the case for local government and overview and scrutiny committees. We think that the more open and legislative approach to overview and scrutiny committees when they are discussing health service bodies is justifiable. They are local authority committees and should be subject to the same regime of public access whatever the matter under scrutiny. That is the broad thrust of our approach. 
 The hon. Member for Isle of Wight was quite right to say that I failed this morning to address the specific point about material held by CHCs. It will be necessary to develop arrangements whereby, as a result of the winding-up of the CHCs, the Secretary of State will clearly be responsible for handling those files in the appropriate way. That may require returning information to individuals.

Paul Burstow: Will the Minister develop that point a stage further? If the Secretary of State has to decide how information is dealt with, will the Minister assure us that in all circumstances the consent of patients or relatives will be sought before the information is passed on to some new body?

John Denham: We shall need to work through the exact arrangements in detail but, on first hearing, the hon. Gentleman's suggestion sounds eminently sensible. The Secretary of State will have to act properly with regard to the fact that the information is personal and confidential.
 Question put and agreed to. 
 Clause 8 ordered to stand part of the Bill.

Schedule 1 - Exempt Information Relating to Health Services

John Denham: I beg to move amendment No. 189, in page 58, line 37, leave out from `Authority' to end of line 38.
 In the old days, before programme motions, one could happily dwell on one or two amendments for an entire afternoon. These days, the mind has to switch from topic to topic much more quickly. 
 This amendment amends paragraph 8 of schedule 1, which relates to GPs providing general medical services, or other practitioners providing services under part II of the National Health Service Act 1977, such as dentists. The amendment ensures that the description applies not only to those practitioners who provide services in the area of the scrutiny committee's local health authority, but to any part II practitioners. 
 Paragraphs 10 to 12 are intended to prevent the public disclosure of confidential or personal information about GPs and other primary care practitioners. The provisions also apply to their employees, such as practice nurses, placing them in the same position as employees of NHS bodies under paragraph 1 of the schedule. In practice, a scrutiny committee may deal with a wide range of different NHS bodies, and that may involve information going beyond that concerned solely with the committee's own area. 
 At present, paragraph 10 refers only to the part II practitioners on the list of the scrutiny committee's local health authority. However, there is no reason to protect only local GPs and not GPs in neighbouring health authority areas. Paragraph 11 already applies generally to providers of personal medical services or personal dental services, as does paragraph 1, which concerns the employees of NHS bodies. The amendment merely brings paragraph 10 in line with those provisions. 
 Amendment agreed to. 
 Schedule 1, as amended, agreed to.

Clause 9 - Public Involvement and Consultation

Desmond Swayne: I beg to move amendment No. 246, in page 7, line 39, after `Authorities', insert `(including Special Health Authorities)'.

David Madel: With this it will be convenient to take amendment No. 79, in page 7, line 39, at end insert—
 `( ) Special Health Authorities'.

Desmond Swayne: Clause 9 places a duty to consult and involve persons for whom services are provided on health authorities, primary care trusts and NHS trusts. Our amendment would include special health authorities.
 We have to put the case for the inclusion of special health authorities, but I rather hoped that the Minister would persuade me why they should not be included. They provide services to consumers, as set out in the clause. I notice that line 31 of page 7 states that people may be involved ``directly or through representatives'', which strikes me as entirely appropriate to our amendment, given the nature of special health authorities and the people that they serve. It strikes me that the clause was almost designed to accommodate them through representatives. 
 I look to the Minister to either accept the amendment or tell us why special health authorities should be excluded from the provisions.

John Denham: Essentially, the reason for not including special health authorities is that by 2002, when the scrutiny committee procedure is in place, there will not be special health authorities providing services directly to patients, certainly in the way that we have been discussing. At present there are 17 special health authorities, but only the three special hospitals—Broadmoor, Ashworth and Rampton—provider health services directly to patients. The others provide a service to the NHS or carry out some other health service function on a national basis, for example the Prescription Pricing Authority, which administers prescriptions and payments to pharmacists.

Philip Hammond: Would the Minister rule out the possibility that a special health authority would be created in the future to provide other services directly to patients? It is a mechanism that the Government has already used a couple of times to implement provisions quickly.

John Denham: We certainly have no intention to do so. We have moved away from the special health authority model. As the hon. Gentleman will know, the services provided by Broadmoor and Rampton will be provided by trusts and that is clearly the direction in which we wish to go in respect of Ashworth, too.
 Our approach has been to build into the organisations that have been set up under the provisions of special health authorities their own arrangements for patient involvement. The National Institute for Clinical Excellence, for example, was established as a special health authority and NICE has its own arrangement. We ensured, for example, that the partners council of NICE would have representatives of the health professionals and patients and carer interests as well as other involvement. That is the approach that we prefer to take. The hon. Member for New Forest, West asked me why we had excluded special health authorities. It is because they are not direct providers of services to patients in the same way as the other bodies that we have mentioned.

Paul Burstow: We, too, have sought to include in the Bill a requirement that special health authorities are part of the new empowering regime within the NHS. That is not least because of our concerns about the operation of NICE, particularly in regard to the discharge of its responsibilities in respect of appraisal of new health technologies and therapies. I was led to table the amendment by the experience of patients and patients' organisations in respect of the appraisal of beta interferon and copoxone. I do not want a long discussion about it because I think it is more appropriately debated elsewhere. However, that case signals why, although the legislation that established NICE may well contain regulations and obligations concerning the involvement of patients, the provisions have not translated into practice. As a result, many people outside the House have experienced a very unsatisfactory set of arrangements in respect of that appraisal and fear that that practice—which has also entailed the wholesale rewriting of the rules in regard to appraisals—has led to great concern about the way in which NICE is discharging its duties.
 For that reason alone, let alone some of the arguments that have been put forward by Conservative Members, we feel that it would be of benefit to have special health authorities included in the Bill so that they too can be part of the new empowerment agenda that the Government are advancing.

Desmond Swayne: I am not entirely sure that I follow the Minister's logic. I cannot understand how special health authorities do not provide a service direct to patients any more than health authorities do. Once the primary care trusts have been set up, in what way would a health authority provide services more directly to patients than a special health authority? I do not understand the distinction that he is drawing between the two. If one falls within the provisions of the clause—the requirement to consult, particularly with respect to the planning of services—I do not understand why the other should not.

John Denham: I would like to respond to the point raised by the hon. Member for Sutton and Cheam regarding the National Institute for Clinical Excellence. Like him, I do not wish to get into a debate about beta interferon. NICE would probably state that it had made considerable efforts, during its appraisals, to consult with patients' organisations and to seek the views of patients. We need to draw a distinction between that and any inevitable disappointment there may be at the conclusions that have been reached, or at the fact that no conclusion has been reached. It would be difficult to mount a case that NICE has not attempted to involve patients in its work, although there is, undoubtedly, always scope for improvement.

Paul Burstow: Just for the record, the Minister says that it would not be possible to advance a case to that effect. Does he accept that in respect of the appraisal of the disease-modifying treatments for multiple sclerosis, the appraisal committee specifically refused to take personal testimony from patients at its hearings?

John Denham: For good reasons, the Government have not been drawn into detailed discussions about NICE and beta interferon. We have eschewed comment until the appraisal is over. However, I understand that NICE received evidence—

Philip Hammond: Will the Minister give way?

John Denham: No, I will not, because I am still answering the previous intervention. I have hardly started.
 I believe that NICE would state that it took evidence from appropriate patients' representatives, but I do not want to go further into a detailed discussion about beta interferon at this stage.

Philip Hammond: Before the Minister moves on, will he give way?

John Denham: I was going to answer the point made by the hon. Member for New Forest, West. Health authorities are a key part of the local provision of services. They may not be, except in certain specialist areas, direct providers of services, but they undoubtedly have a key role in shaping the provision of services at local level. For that reason they should fall within the provisions of clause 9, alongside the other direct providers of patient services.

Philip Hammond: I should like to return to the Minister's explanation to the Committee of the Government's reticence on the issue of NICE and beta interferon. Will he tell the Committee whether it is expected that the Government will be in a position to talk about the issue before the general election, or does he expect that they will only be in such a position after the general election?

John Denham: The general election could be in May 2002. NICE has said that it wishes to reach a conclusion by this summer, so we may well be in a position to discuss that conclusion before the general election.

Desmond Swayne: I think that I might reassure my hon. Friend that this Government certainly will not have an opportunity to discuss those issues after the general election—that is for sure. The Minister's logic for excluding special health authorities has not been persuasive, but that is not a matter that we wish to pursue now, and I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

Desmond Swayne: I beg to move amendment No. 247, in page 7, line 41, at end insert—
 `(2A) It is the duty of every body to which this section applies to publish annually (in such manner as it reasonably believes appropriate) a report on the arrangements it has made to discharge its duties under subsection (1) above'.

David Madel: With this it will be convenient to take amendment No. 80, in page 8, line 8, at end add—
 `( ) Every body to which this section applies shall include in their annual report details of the arrangements maintained in that year for obtaining the views of patients, carers and the wider community.'.
 Sitting suspended for a Division in the House. 
 [GW1]I think all this procedure is right - log's a bit confused and so am I.[TMB2]Unable to find a note on this. 
 On resuming—

Desmond Swayne: As I no doubt would have got round to saying, had you not interrupted me at such an opportune moment, Sir. David, amendment No. 247 places a duty on those bodies specified in clause 9 to produce an annual report to demonstrate how they have informed and consulted on the planning of the services that they make available, the development and consideration of proposals for any changes that they may have and any decisions that they have taken. It begs the question that if there is no annual report in which those bodies are required to demonstrate how they have met those provisions and consulted in that way, how else are they to be scrutinised, given the statutory responsibilities that are placed on them in the clause. I should be interested to hear how the Minister is planning to ensure that those functions are carried out. We believe that the best way would be to do it in an annual report and that that annual report should be available publicly for scrutiny. Not only will that be an effective tool for ensuring that the functions have been carried out, but we believe that it will be a powerful engine for generating best practice within the NHS by comparison between the different bodies concerned. We will be able to use those annual reports as an effective tool for measuring one against the other and generating a levelling-up across the board.

John Denham: We will certainly see something akin to an annual report. Indeed, what we have proposed is that there should be a patient prospectus for all trusts, which should say how they have taken the views of patients into account. In fact, a prospectus will go further than that because, for the first time, people will be able to read not only what patients think of their local hospital but how the trust's management have taken patients' views on board to improve services. The prospectus will set out how trusts have gathered patients' views through the new trust level patient survey and show the results of the survey data. Patient surveys will contain core questions that will enable trusts to monitor progress in areas identified nationally for specific improvements in services such as primary care access, food and cleanliness. There will also be scope for additional questions to be included that reflect local circumstances. We will expect the patients forum, and the trust management, to identify the areas to be covered by the additional questions, and for the patients forum to then take the lead in developing those questions.

Philip Hammond: Is this not just another example of doublespeak? Does not a prospectus, in the normal course of language, imply that people have a choice? People review prospectuses and decide where they want to go. Can the Minister back up his choice of the word ``prospectus'' with any prospect of real choice being introduced for patients?

John Denham: The prospectus normally sets out what is on offer, and that is precisely what a trust prospectus will do. Of course, under the failed internal markets, health authority bureaucrats had to second guess the choice made by clinicians. Now that Conservatives are commissioned at local level by front-line clinicians, they are much more involved in shaping services. So ``prospectus'' is a totally appropriate word.
 For the record, I will say a little more about what the patient prospectus will do. The patients survey will be included. Trusts will have to show what action they are taking to deal with shortfalls identified through the patients survey. We expect the trust to share the survey data with the patients forum. We expect them both to agree local standards for all the service improvements. The prospectus will contain information on a range of local NHS services and non-NHS open information such as voluntary organisation addresses and telephone numbers. It will act as a single vehicle for publishing local targets and standards, how they were measured, progress made against them and new priorities for the next year. 
 However, the emphasis is on an evolving document that may change in shape over time. For those reasons, we do not regard the amendment as necessary, but I hope that the Government have made their intentions clear.

Desmond Swayne: The hon. Gentleman has told us about a prospectus, for which there may be some justification—there is certainly some justification for the provision of telephone numbers—but it is a very different document and it raises the question of whether, when there is only one item available, a prospectus is required. Patients by and large will not have the choice to consume those services or not. They are patients rather than consumers. It is not as though they can take the option often enough to go elsewhere.
 ``Prospectus'' is not the appropriate term. We are looking not for a glossy, promotional publication, but for a means of scrutinising whether the health authorities or the PCTs have met the requirements of the clause on public evolution. We are looking for an annual report that will scrutinise and be able to measure their performance. The Minister has told us about a prospectus in which they would seek to give an account of their performance in the most advantageous manner, as one would expect with any prospectus. It is not the same document, but the hour is late and we are not going to press the matter. I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Question proposed, That the clause stand part of the Bill.

Peter Brand: On a point of order, Sir David. It would have been helpful if you had indicated at the beginning of the debate on the clause whether there was to be a stand part debate on the clause. I certainly would have wanted to make some points on that.

David Madel: If the hon. Gentleman wishes to address the matter, it is still open.

Peter Brand: I am very grateful.
 The clause is interesting. It clearly requires all bodies involved in the national health service to consult. That involves commissioning as well as delivery units. I have a specific question for the Minister: will the bodies that can be set up under clause 4, the public-private partnerships, be caught by the clause? 
 I am particularly interested in the fact that clause 10 is quite specific about what form the public consultation will take. We will get to that later, but I ask the Minister to be a little more specific about what actions he expects from health authorities in discharging their duties in relation to clause 9. Has he given some thought as to how the competing—often, it will be competing—patient and consumer involvement with the consultation will work out in practice? 
 There is no doubt in my mind that trusts are extremely good at public consultation where the subject is particularly emotive. I also know that health authorities sometimes find it difficult to persuade the public to support a particular course of action that cuts against the interest of an individual trust. It is laudable that each trust shall have a patients forum, but I am concerned that we are not setting up a mechanism that allows us to balance the special pleading that will take place on behalf of clinicians within trusts with the public health requirements of a broader population, which will be the strategic responsibility of the commissioning health authority.

John Denham: Let me concentrate on the specific point raised by the hon. Gentleman. The clause places a general duty on NHS bodies, which needs to be backed up by guidance. In that sense, it is akin to the general duty on quality that was introduced under the previous Act. None the less, it provides the responsibilities under which clinical governance is developed in the NHS.
 I had the opportunity earlier to illustrate some of the ways in which a trust might involve patients by seeking their views and reporting on them. Health authorities will need to take a similar flexible approach. Clearly, one of the ways in which they can address such a duty is through the consultation that they will be expected to undertake with the local advisory forum. As was said earlier, we have been non-prescriptive at local advisory forum level. Health authorities throughout the country have already put their toe in the water. For example, Somerset has an advisory forum that brings together health panels in each PCG area. It has a total membership of about 36 people from the localities to discuss the broad direction of the local health economy. Sunderland went a stage further: it has a pool of 350 people on which it calls with a citizens jury-type approach. I understand that the Norfolk health authority's citizens panel comprises about 4,000 people. That illustrates the wide variety of different consultative methods that have been developed by health authorities throughout the country. 
 I do not believe that one particular model is self-evidently better than the others. We want health authorities, with the support of the Department, to draw on best practice that is already being developed in the country. That may be the way in which the health authority fulfils its obligations under the clause. Everyone accepts that good consultation means flushing out different and difficult points of view. Clearly, a duty to consult is not the same as a duty to take the majority opinion in a straw poll. Health authorities will remain accountable for their decisions, but we shall be helping them to develop consultative structures that enable all the issues to be identified effectively to influence their approach.

Peter Brand: Will the Minister admit that there may be a difficulty with an approach whereby a statutory body supports a trust and a vague ``Do it as you wish'' arrangement is made for the commissioning authority?

John Denham: I do not agree. There is a difference between developing the most effective ways of having input into the strategic leadership role played by the health authority across the health economy as a whole and the focused function that is at the core of the patients forum work, which identifies the patient view and interests in relation to that organisation. Under that system, each element is designed for the job that we have asked it to undertake. There is no obvious reason why one should be specified fairly clearly, while a loser approach is taken to a different element at this stage in the development of the system.
 Question put and agreed to. 
 Clause 9 ordered to stand part of the Bill.

Clause 10 - Establishment of Patients' Forums

Peter Brand: I beg to move amendment No. 46, in page 8, line 9, leave out `Secretary of State' and insert
`local authorities specified in section 7(2)'.

David Madel: With this it will be convenient to take the following amendments: No. 47, in page 8, leave out lines 10 to 12.
 No. 48, in page 8, line 16, leave out `trust' and insert `trusts'. 
 No. 49, in page 8, line 18, leave out `trust' and insert 
`overview and scrutiny committee and relevant trusts'.
 No. 50, in page 8, line 20, leave out `trust' and insert 
`overview and scrutiny committee and relevant trusts'.
 No. 51, in page 8, line 25, leave out 
`A Patients' Forum for a' 
and insert `In respect of'. 
 No. 52. in page 8, line 25, leave out `Trust' and insert `Trusts a Patients' Forum'. 
 No. 53, in page 8, line 33, after `Authority', insert 
 `and overview and scrutiny committee'. 
 No. 54, in page 8, line 35, after `Authority', insert 
`and overview and scrutiny committee'.
 No. 55, in page 9, line 4, leave out `for' and insert `duties in respect of'. 
 No. 42, in clause 12, page 9, line 21, leave out `trust' and insert `trusts'. 
 No. 43, in page 9, line 21, leave out 
 `for which it is established' 
 and insert 
`it covers and the establishing local authority'. 
No. 60, in clause 13, page 10, line 5, leave out `trust' and insert `trusts'.

Peter Brand: I was grateful to have an opportunity to speak in the clause stand part debate on clause 9 because it was so relevant to clause 10. It is right that each trust should have a patients forum, but it also important that these patients forums do not become the tame possession of that trust. I hope that we are not seeing a statutory establishment of leagues of friends of particular hospitals, and particular trusts. My experience of lay involvement, and some of the criticisms of community health councils voiced earlier today, shows that the lay public are well disposed towards health providers as a rule, and there is a great risk of them going native—if one dare use that term.
 Our amendment would result in the patients forums becoming a more cohesive power. While it is important that they have a link with the trust, it is equally important that they are required to work collectively. This could be within the health authority area, but we have chosen to go the route of the local authority area, which would match the arrangements that we have already established. 
 It is important that patients forums are seen to be representative of the public, rather than representative of the trust. For that reason, we suggest that the local authority, mirroring the arrangements that we discussed earlier, should be the umbrella body for these patients forums. This would increase the local accountability, rather than the direct trust influence.

Desmond Swayne: I have a question, which follows on from what the hon. Member for Isle of Wight has said. We are told that the membership for the patients forums is to be drawn from local patient and voluntary groups—he is right to point out the importance of the voluntary groups—of which the league of friends will be one. Half of them will be drawn from the respondents to the trusts' annual surveys. The explanatory notes go on to say that members of the public who will be appointed to the patients forums must have been treated, or still are being treated, by an NHS trust or by a PCT.
 I suspect that a significant portion of those being treated by trusts are children or are elderly and infirm. It is most appropriate that those who care for these patients should be allowed to sit on the forums, because they will have a great insight into the problems of, and the services provided by, those trusts. The requirement that those serving on the forum must have been recently treated or still being treated, leaves out a whole category of people who would be very useful to the forum.

John Denham: The hon. Member for Isle of Wight raises a number of issues. First, should the forum relate to the trust or cover a wider area? Secondly, will the forums become of the trust rather than relating to the trust—in other words, will they loose their independence? Thirdly, the relationship with the local authority was raised. The fourth issue, raised by the hon. Member for New Forest, West, is whether the broad proposal that we have set out for membership is right for the function of the patients forums.
 The patients forums will be independent of the trusts to which they relate because the provisions of the Bill establish them as independent and statutory bodies, because they will be funded separately to the trusts and because they will have clear powers in relation to the trust. Their membership will be appointed by the independent appointments commission, rather than by the trust. They will be able to select a non-executive director of the trust and will have the powers to carry out visits and inspections, which we discussed earlier. They will have specific functions. 
 Under clause 9, we discussed the patients prospectus, but I omitted to say that we intend the patients forum to have the right to sign off the patients prospectus. The fears that were expressed about a glossy document saying how wonderfully the trust was doing will not be realised. The patients forum will need to agree that what the prospectus says about patients' views is correct. For all those reasons, the patients forum will be an independent structure. 
 The big question is whether the patients forum should relate directly to an individual trust or primary care trust or whether it should cover a wider area. There may be a simple philosophical difference between hon. Members on both sides of the Committee. The Government believe that the forum needs to relate to the particular organisation, its management structure, culture and ethos if it is to bring about change. 
 A patients forum that covered a wider area would have huge attractions in some ways, because not as many patients would be needed, it would not cost as much to run and so on. However, such a forum would be too remote from any individual organisation and its management structure to effect change on the patients' behalf. We may have to accept that there is a difference in view between hon. Members on different sides of the Committee. 
 None the less, it will be interesting to explore the potential relationship with the local authority, which is where the hon. Member for Isle of Wight sought to locate the larger patients forum. There are attractions in the idea that a local authority could offer a base or secretariat that supported a number of patients forums in the area. That would enable each forum to be individually independent and established in law. They would relate to an individual primary care trust or NHS trust, but share a common base or secretariat in the local authority. However, there are practical models of administration and co-ordination that would provide what we want to achieve, while delivering co-ordination across the patients forums in an area. 
 I said that the NHS appointments commission would appoint the membership. We envisage that part of the membership will comprise people who are or have recently been patients of the trust, perhaps drawing on people who have taken part in the annual patients survey. Others will come from local voluntary and patients' organisations. We are clear—probably clearer than the explanatory notes as I recollect—that carers must also be represented in the membership. They will form an important part of the membership of patients forums.

Peter Brand: I am slightly confused. I think that we are covering amendments Nos. 81 and 82 at the same time as the constitution of the membership of the forums. I am quite happy to address that issue during this debate, because those are clearly exploratory amendments.
 The Government are being too prescriptive by saying that the membership must be made up of past patients. Health care is not only about ill people, but about the larger community--people who want to avoid becoming ill and the steps that one can take and that trusts ought to take to promote that. I hope that the Minister will look again at the explanatory notes and the Bill, and not be quite as prescriptive on the membership of the bodies, because it will be difficult to find good people to serve on them anyway. 
 I am all in favour of more public involvement, but it must be real, rather than token, public involvement. I would not want to see the same busybody appearing on all forums at all times. Those of us who serve on voluntary bodies tend to meet the same people wearing slightly different hats—until, of course, they arrive in Parliament, having polished the front door plate often enough. As regards membership, it would be helpful if people could serve on more than one forum. For example, they might serve on a trust forum as well as an advisory body. 
 I was encouraged that the Minister recognised the need to support patients forums that relate directly to one trust, and that there is great merit in allowing or, indeed, requiring those forums to work together. In that way, members of the forums may not only develop a feel for what happens within the trust—I agree with the Minister that that is essential—but appreciate how that relates to the wider picture and other people's experience. Given those circumstances, I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn.

John Denham: I beg to move amendment No. 190, in page 8, line 22, at end insert—
'(da) in prescribed circumstances, to perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families;'.
 The amendment provides for a specific element of power to be placed in the hands of patients, carers and representatives through patients forums. We believe that the patient advocacy and liaison services needs to be based in, and managed by, the trust and primary care trust. That is the way in which patients will be most effectively supported and assisted. 
 We recognise that such an arrangement might not work if the trust management were hostile. The amendment enables us to set up a system in which a patients forum that was concerned and able to show that a PAL service was consistently falling below acceptable levels of quality would be able to refer the matter to the Secretary of State, who could then specify that the PALS be withdrawn from the management of the trust or PCT, to be run in an alternative way. That would provide for the possibility of its being placed under the control of the patients forum. I regard that very much as a last resort and a long stop, and do not believe that it would be widely used. However, we have been convinced that it would be worth taking such a power as a protection against an advocacy and liaison service that was not allowed to operate effectively within the trust.

Philip Hammond: The Minister has clarified what was in many of our minds—that is, what the Government had in mind when tabling the amendment. Will he explain a more general point that has troubled me? Why is it appropriate to establish patients forums through the Bill, with all the rigmarole that that entails, but not to establish the independent local advisory forum or the patient advocacy and liaison service in the same way?
 From the remarks that the Minister made during the previous debate, it seems that the independent local advisory forum will be the key element in any strategic overview of service rearrangement. It might be argued that that is a more formidable and strategic function than the one performed by the patients forum. Why the asymmetry in the design of the arrangements?

John Denham: With regard to PALS, as we discussed earlier, no comparable powers of functions of trusts are specified. With regard to patients forums and the advisory forums, the Secretary of State has the power, by directions, to do as the hon. Gentleman suggested. However, a patients forum established by direction of the Secretary of State to a trust would have too close a relationship to the trust to have the necessary independence of voice that people want from the system. We acknowledge in the Bill that the Secretary of State could have set up those bodies by direction.
 A number of health authorities already adopt an advisory forum approach, which shapes their policy. I do not see that it needs to be independent in the same way, as it is an advisory body, a listening body, a sounding board and a body with which the health authority works in developing its strategic approach to the local health economy. The power that the Secretary of State has to establish it by direction will be sufficient. It is not playing the same role of representing the patient in relation to a specific organisation; that is a different function.

Philip Hammond: I accept that distinction, but does the Minister accept that the ILAF is taking over what many people will see as one of the key functions of community health councils without the statutory backing in primary legislation that, for example, patients forums have? There is a suspicion that that amounts to a downgrading of that part of the CHC function?

John Denham: I believe that, in practice, the advisory forums will be more effective, more powerful and more influential on the future development of strategy than CHCs have often been able to be, despite their statutory role. That is certainly our goal and it is how we intend to go about establishing them.

Paul Burstow: In the briefing sent to hon. Members, we are told that these bodies will be combining the views and experiences of all patients' forums within the single health authority area. The briefing says that they are seen as the arena where patients can look across the health economy. Surely those functions are vital to securing the oversight of the whole system. Surely the bringing together of these matters should be footed firmly in the Bill and not be the subject of direction and discretion by the Secretary of State.

John Denham: I do not believe that that is necessary. Given how clearly we have set out what we expect the organisation to do, the Secretary of State's powers of direction will be perfectly adequate.
 Amendment agreed to. 
 Mr. Swayne: I beg to move amendment No. 249, in page 8, line 22, at end 
 insert— 
 `( ) to belong to and cooperate with any body established by regulation to represent at national level the Patients' Forums created under subsection (1) above'. 
 The Chairman: With this we may discuss amendment No. 29, in 
 page 8, line 24, at end insert— 
 `(f) to provide advice, and make reports and recommendations, about matters relating to those services, including patients' views on those services, to the Association of Patients' Forums, established under section (Association of Patients' Forums).'
 New clause 3—Association of Patients' Forums— 
 `.—(1) The Secretary of State shall establish an independent national body, known as the Association of Patients' Forums, with a duty to provide a national overview of the patient experience to the Secretary of State and National Health Service bodies, on a regional and national level. 
 (2) The Secretary of State shall make regulations for the purposes of subsection (1) above. 
 (3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations.'.

Desmond Swayne: When I looked at the great pile of briefs in my in-tray this morning, I was gratified to see that it appears that a large number of those providing the briefs find themselves in support of the principle that lies behind our amendment. That was certainly my understanding having read the brief from the Consumers Association, the citizens advice bureaux, the Royal College of Nursing and ACHEW—I do not know who thinks up these acronyms. The Association of Community Health Councils for England and Wales takes a strong view of the principle to which amendment No. 249 gives expression. That association will be abolished as a consequence of the Bill. There will, therefore, be no provision for a national body in England and Wales to provide an overview of the patient forums we have been discussing. That is an important role and there should be an umbrella organisation to provide a whole range of functions, such as staff training, particularly of volunteers, promoting the exchange of best practice and the provision of performance standards and expert advice, whether that be human resources advice, research and publications or legal services.
 One of the complaints that we have heard repeatedly is that the service provided by community health councils was patchy—the word ``patchy'' has been used—and that it was not always of a uniform standard. That was when there was an umbrella body specifically to provide community health councils with a measure of the support and the sharing of best practice that I have described. Consider how patchy the performance of forums is likely to be without the provision for that central umbrella organisation. 
 It strikes me that, under the Bill as constituted, there is no provision to enable information about the NHS at a local level to be used to influence national policy, but an umbrella organisation for patients forums would provide that. People should be able to expect the same standard of representation from forums wherever they live. That would be fostered—and there would be a powerful engine for sharing best practice—if such an organisation were set up. On Second Reading, the Secretary of State implied that the Department of Health was considering the feasibility of forming such an organisation to act as an independent umbrella body. For all we know, that may even have been announced down at Fulham today, where I understand that further examination of such issues is strangely taking place. We believe that it is an important role, and the Royal College of Nursing believes that 
``such a role is vital if patient forums are to operative effectively.'' 
What will be the relationship between patients forums and, for example, the Commission for Health Improvement inspectors? Will they work with patients forums as a matter of course? I digress slightly from the issue of an overarching body, but such a body would provide guidance to members. Nevertheless, it is a good question. Without a central body, who will be responsible for recruiting, appointing and training the servants of forums? What training will be given? How will they be funded? Will funding come via the health authority, the trusts or primary care trusts? Will the reports that they will inevitably publish be made public, and be a matter of public scrutiny? All those are issues that we would expect to be thrashed out by an umbrella body, thereby establishing best practice. If there is no provision for such a body, as is the case under the Bill, will the Minister say how such issues will be addressed?

Peter Brand: Amendment No. 28 and new clause 3 try to achieve the same end. It is essential to have a national arena in which patients forums can share information, for two reasons. First, forums will be able to carry out their functions better at local level by networking nationally, and sharing experience and knowledge. After all, health authorities network and share experience and knowledge, as do trusts. It would be wrong to place the patients forums at a disadvantage. Secondly, it is important that the national strategic thinkers for this country's health system have access to a national body representing patients forums. The process would therefore work in two directions. That cannot be left to accident or whim; it must be established, if only to ensure that such an organisation is funded.
 On a minor note, ACHCEW—a wonderful acronym—has been a fruitful source of Members of the other place with great knowledge of the national health service. I would hate the Government to be deprived of such expertise.

John Denham: As I said this morning, we are sympathetic to the idea that there needs to be some form of national body to reflect patients' views. That is why we funded the first part of a study proposed by the College of Health, the Long-Term Medical Conditions Alliance and the patients forum, to which we have given £20,000 in the first instance. One of its aims is to identify the options for a national patient body.
 The research brief states that 
``a number of the demands arising from'' 
the Government's 
``proposals are best supported on a national basis. For example, support for the recruitment, appointment and development of patient and public representatives; national guidance to ensure that work is properly undertaken. There are also questions about how best to pull-together and roll-up local information to ensure influence on regional and national services and policy developments. Fundamentally, there is a need to be confident that the new arrangements will ensure the system for involvement in the NHS is being strengthened''. 
That is part of the brief that we are supporting. 
 The scoping study is regarded as the first stage in two subsequent studies on, first, the detailed design of a national patient involvement organisation, and, secondly, plans for its implementation. That study is already being supported. Among the aspects that it will examine are the scope for a new national body, its main roles and functions, the models of good practice and current capability that it should draw on and what, if any, formal powers and authority it would require. We are moving broadly in the direction suggested in the amendments, but I would not want to tie us to the specific models implied in the amendments. There is no need for the national body to be set up on a statutory basis, as has been agreed by some of the organisations that are taking part in the study. We are considering the issues that underlie the amendments.

Doug Naysmith: Has my hon. Friend the Minister any idea how long the study will take and when we can expect results?

John Denham: We hope to receive the results of the scoping study by 31 March, when we shall be able to move on to the other studies that I have mentioned.

Peter Brand: I am in no way persuaded by the Minister, which is unusual, because he usually makes a strong case. I do not understand why we need research or a consultant to establish the scope for a national body. Perhaps he wants to be absolutely certain that a national body will be tied to ministerial restrictions, so that it restricts itself to comments on matters on which the Minister is prepared to receive representations. If we are to have a national body representing patients forums, it is for those patients forums collectively to determine the agenda of that body. The only study that the Minister must do is into how to fund it. Spending £20,000 on calculating how much it might cost to duplicate ACHCEW seems a waste of Government money. We are being presented with £20,000-worth of buying time and paying off organisations that recognise a need for a national presence on the matter.

Desmond Swayne: The Minister said that the first of the studies would be received by 31 March. That strikes me as taking the Government out of any significant danger in relation to the Bill in Committee and, indeed, the House, although perhaps not so with respect to its passage in another place. We shall consider carefully what the Minister has said, and we shall consult outside bodies with a view to returning to this matter, or it may receive further scrutiny in the other place.
 I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Amendments made: No. 191, in page 8, line 23, leave out 
`by regulations made by the Secretary of State'. 
No. 192, in page 8, line 33, at end insert `and the trust'. 
 No. 193, in page 8, line 35, at end insert `and the trust' 
 No. 194, in page 8, line 41, leave out 
`(within the meaning of the 1977 Act)'. 
No. 195, in page 8, line 43, leave out from `of' to `, and' in line 44 and insert 
`section 31 arrangements in relation to the exercise of health-related functions of a local authority'.
 No. 196, in page 9, line 1, leave out `in pursuance of such' and insert 
`(and not as part of the health service in England) in pursuance of section 31'.
 No. 197, in page 9, line 3, leave out `subsections (2) and (3)' and insert 
`this section-- 
 ``the health service'' has the same meaning as in the 1977 Act; 
 ``patient'' includes (as well as a patient within the meaning of that Act) a person who receives services provided in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority; 
 ``prescribed'' means prescribed by regulations made by the Secretary of State;'.
 No. 198, in page 9, line 5, at end insert— 
 ` ``section 31 arrangements'' means arrangements under regulations under section 31 of the Health Act 1999 (arrangements between NHS bodies and local authorities).'. —[Mr. Denham.] 
 Clause 10, as amended, ordered to stand part of the Bill.

Clause 11 - Patients' Forums: Entry and Inspection of Premises

Philip Hammond: I beg to move amendment No. 250, in page 9, line 6, leave out subsection (1) and insert—
`(1) Authorised members of a Patients' Forum shall be permitted (subject to subsection 2 below) to enter and inspect, for the purposes of any of the Patients' Forum's functions, premises owned or controlled by—
(a) a Health Authority, or
(b) a Primary Care Trust, or
(c) an NHS Trust, or
(d) a person providing services under Part II of the 1977 Act or under arrangements under section 28C of that Act.'.

David Madel: With this we may discuss the following amendments:
 No. 83 in page 9, line 6, leave out `may' and insert `shall'. 
 No. 84 in page 9, line 13, after `inspect', insert `by arrangement and unannounced'. 
 No. 251, in page 9, line 15, after `The', insert 
`Secretary of State shall make regulations in relation to the powers granted under subsection (1) above, and the'.
 No. 238, in page 9, line 16, leave out `cases and' and insert `exceptional cases or exceptional'. 
 No. 239, in page 9, line 16, after `is', insert `not'. 
 No. 252 in page 9, line 17, at end add— 
`(3) The Secretary of State shall make regulations providing for— 
 (a) publication of a report of any inspection carried out under this section; 
 (b) submission of any such report to the body controlling the premises inspected; and 
(c) publication of a response from the body controlling the premises inspected.'. 
 Clause stand part. 
 No. 86, in clause 12, page 9, line 22, at end insert— 
 `(1A) Every Patients' Forum shall also— 
 (a) prepare reports on matters arising from premises visited within 60 days and send the same to the relevant Trust, overview and scrutiny committee, ILAF, and Health Authority, which bodies shall be required to respond; and 
 (b) have the right to refer any matters to the Secretary of State for action in the event that it is dissatisfied with the response from the above bodies'. 
Mr. Hammond: Amendments Nos. 250 and 251 would change slightly the architecture of this clause. Instead of ``allowing'' the Secretary of State to make regulations'', it would state that the Secretary ``may'' make regulations. The amendments would insert in the Bill the requirement to allow authorised members of a patients forum the right to enter the premises of certain health bodies—thus enshrining that right in primary legislation—and would require the Secretary of State to make the necessary regulations to govern the way in which that arrangement is to work. 
 We think that the right of patients forums to enter the premises of designated NHS bodies is so absolutely fundamental to the performance of their function that it must be written into the Bill, and not left as something the Secretary of State may do by regulations. We fully accept that there will have to be arrangements governing the exercise of those powers, which will have to be preserved in regulation-making powers by the Secretary of State. 
 Every member of the Committee will be familiar with the Casualty Watch bulletins produced by community health councils. One of the high profile and very important functions of community health councils is to monitor what is actually going on in hospitals. A picture speaks a thousand words, and a snapshot that Casualty Watch can provide over a 24-hour period often gives us a clearer view of what is really going on in an NHS organisation than all the statistics published--or not published--by the Department of Health. I will judge the Government's motive in making these changes to the NHS's overview and scrutiny arrangements by the output of the new bodies. 
 If we do not continue to see a regular flow of often very embarrassing Casualty Watch reports, which contradict assurances that Ministers give to the public and to the House, and if we do not see these new organisations blowing the whistle on scandals or irregular practices occurring around the country, then we will know that the Government, in making these changes, have not improved the scrutiny and oversight of the NHS: they have diminished it. 
 For that reason, we believe that the right of entry must be enshrined in the Bill. It must, of course, be properly hedged around by regulations to ensure that the exercise of those powers does not damage the clinical effectiveness of the premises being visited. We see no reason to delegate this to a regulation-making power that the Secretary of State may or may not exercise. 
 Amendment No. 252 enables the Secretary of State to make regulations providing for the publication of reports of inspections carried out under clause 11, the submission of those reports to the NHS body concerned and the publication of the NHS body's response to those reports. Anything less than that will not provide effective public scrutiny or enable the patients forums to perform their function effectively.

Paul Burstow: I want to ask a couple of questions arising out of page 15 of the explanatory notes, to which my hon. Friend the Member for Isle of Wight referred this morning. It would be helpful if the Minister could provide some further clarification. Paragraph 69 talks specifically about access and states:
 ``Access will generally be limited to areas where patients are permitted access (including consulting or treating rooms) and to reasonable times agreed''. 
My hon. Friend rightly identified a number of places where patients may not normally seek access. However, in discharging a patients forums responsibilities, they should properly have access to places such as the mortuary, kitchens, laundries and so on. It would be useful if the Minister could confirm that the explanatory notes are wrong and that it is the Government's intention to widen it in that way. If not, it would be unfortunate if the explanatory notes were taken to be the basis of what this clause is about. 
 I want to talk about the amendments standing in my name and that of my hon. Friend the Member for Isle of Wight. What we are seeking to do here, in the same way as the hon. Member for Runnymede and Weybridge (Mr. Hammond), is to turn this permissive power to make regulations into a duty on the Secretary of State to make regulations. We then want to go further and stipulate specifically in the Bill that the regulations should allow for unannounced visits. Unannounced visits are invaluable for getting a picture of how the NHS is performing, and when CHCs undertake such visits, they often uncover things that may not revealed if the trust is aware of the visit. It is important that the Government are clear and upfront that they intend and envisage that, in all but the most extraordinary of circumstances, it would it be possible, to undertake unannounced visits in the same way as CHCs do now. 
 Amendment No. 86 deals with the issue of reporting. It seeks to establish that, having undertaken such visits, patients forums should be reporting to the relevant trust after a period of 60 days. Also—this is important to establish the interconnections between the various bodies that are to replace CHCs—it deals with the fact that the forums should report to the overview and scrutiny committees, the ILAF and the health authority. All those organisations that have an interest in how the trust is performing should be in the picture in respect of what the patients forum has found.

Philip Hammond: I understand what the hon. Gentleman is seeking to do. However, as he goes wider, is it not better simply to require publication of those reports, as our amendment proposes?

Paul Burstow: Our amendment seeks to identify the specific bodies and to ensure that the channels of communication exist. As both our amendment and that of the hon. Gentleman are intended to establish the Governments' intentions, I should be happy to support his amendment if there were to be a Division. The key point is that we have greater clarity about reporting lines and that the material is put into the public domain so that scrutiny can be carried through. With that point, I hope that the Minister will be able to give some reassurances, especially about unannounced visits, because of the benefit that they can have for the oversight process.

John Denham: We have made it clear that patients forums should be able to visit and to inspect any aspect of the care provided to patients. The clause provides the framework that enables us to meet that commitment. As the hon. Member for Runnymede and Weybridge acknowledged, we do not want the process to be adversarial or combative—it should be done responsibly and productively. The capacity to make unannounced and short-term visits must be an option available to the patients forum but, in the normal course of inspections, one would want a more structured approach.
 There are key areas vital to patient safety and services that the patients forums should be able to inspect. Equally, there are areas of trust responsibility, such as accommodation provided to nursing staff, for which it is unnecessary to create a right of unannounced inspection by patients forums. However, by agreement with trust staff, patients forums might want to take an interest in that. We must draw a sensible line, but we have no intention of denying patients forums access to places under the right circumstances, when it is relevant to their work.

Philip Hammond: Will the Minister give way?

John Denham: I should like to make progress.
 So that there is no misunderstanding, I want to be clear about the way in which access will need to be secured. We are dealing with different types of premises. It is relatively straightforward, legally, to make it clear through directions that access to NHS premises will be provided. However, it is not appropriate to legislate in the Bill about private premises such as GP premises, because it would raise European Court of Human Rights issues, among others. We intend to seek access to those places through terms-of-service changes for GPs and have notified the profession of that. We intend that access to private sector providers should be provided for within the contract that the commissioning NHS body enters into, as with access by the Commission for Health Improvement.

Philip Hammond: The Minister will forgive me if I draw a stark contrast between what he said about access to private premises and the premises of private providers and the approach taken by the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), in the consideration of the Care Standards Bill. Draconian powers in that legislation allow unannounced access by inspectors to private premises providing care to elderly residents, at any time of the day or night. Why is the Minister proposing a less onerous inspection system for the NHS than is imposed on private sector providers of care?

John Denham: The system for NHS patients should not be any less effective than that for patients in the private sector, but the contractual relationships differ from those dealt with by the Care Standards Commission. I thought it important to set out the ways in which we intended to achieve the aims that we all share.
 Two issues have arisen as matters for discussion. First, it is clear from the Bill that patients forums have a duty to make reports and recommendations to the trust to which they relate. That would include reporting on the findings of inspections and visits. I am not convinced that we need a requirement in the Bill to report formally and publicly every single visit, as that would be a bureaucratic imposition. However, we would expect the patients forums to be able to report in that way. 
 The hon. Member for Sutton and Cheam raised another question, which now escapes me. He may want to raise the matter again.

Philip Hammond: I confess that the Minister's answer has not entirely satisfied me. Opposition Members seek to establish the extent and nature of the access that is granted and an assurance that, in practice, the reporting and publication of visit information will not be less satisfactory than is the case with community health councils. If the Minister can say that it is the Government's intention that any changes will mean greater access to premises and fewer restrictions, that will be of great reassurance to members of the Committee.

John Denham: I am delighted to be of assistance. I can give that assurance.

Philip Hammond: I am grateful to the Minister. We are concerned that that assurance is not reflected in the Bill. We shall think more about the matter and hopefully we can find a way in which to make sure that the hon. Gentleman's intention will be translated into the provisions. However, given what he has said, I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Clause 11 ordered to stand part of the Bill

Clause 12 - Patients' Forums: Annual Reports

Paul Burstow: I beg to move amendment No. 85, in page 9, line 21, after `established', insert
`, the overview and scrutiny committee, the ILAF, the Health Authority,'.

David Madel: With this it will be convenient to take new clause 6—Independent Local Advisory Forums—
 `.—(1) The Secretary of State shall make regulations requiring every Health Authority to set up a body known as an Independent Local Advisory Forum (ILAF), and making provision for such bodies, including the establishment of links with Patients' Forums. 
 (2) It is the duty of ILAFs to provide independent advice to the Health Authority in determining the health priorities for the area and will be made up of residents of the local area including representatives from the local Patients' Forums. 
 (3) Before making regulations for the purpose of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations.'.

Paul Burstow: We have probably trodden this path several times today, but I want to refer again to the non-statutory basis of the independent area consultation bodies that are being established by the Government, but which is not covered in the Bill. During our discussions on the abolition of CHCs and their replacement, I began to wonder if anyone had drawn lines on a chart to show the connections between the various bodies, and I thought that I would have another look at the NHS plan to see whether there was a chart to help me navigate my way through the system. There is not, nor is there a chart in the briefing notes that we were provided with in advance of the sitting.
 I imagine that a chart does exist, but I have not found the right document. It would be useful to see such a chart that showed the lines of accountability for the new bodies, their lines of appointment, the lines of communication between the bodies, the lines of authority for the gathering of information and details about from whom it can be gathered. That would provide us with a better understanding of how the different entities will operate with each other. That is why I want to return to the matter of the local advisory forums. 
 Earlier, the Minister said that the Government wanted to assure themselves and the public of the independence of patients forums—and rightly so. He said that the best way in which to secure such independence would be to give them a clear statutory basis. However, for some reason a body that has within its title the word ``independent'' does not need to have a similar statutory basis. Simply to call a body independent does not make it independent, so I tabled the amendment to give the Government a further opportunity to consider including in the Bill a measure that would deal with that problem. 
 The matter about which I am concerned is not the same as that regarding PALS. The Minister rebutted the amendments that dealt with the patient advocacy and liaison services on the basis that they were specific, managed services within the NHS. My argument is not about a managed service, but about the accountability mechanism that the Government want to put in place. It should have a statutory basis—at least as clear as the one that CHCs have had until now. Not to outline that in the Bill will be a cause of constant concern. It will give rise to the possibility of a considerable divergence of practice from one health authority to another. 
 Moreover, as a result of the reconfiguration of health authorities in London, we shall have large health authorities in London and probably in other parts of the country, too. Those bodies may have to consider whether one independent advisory forum is necessarily the appropriate structure. I hope that the Minister will give some further thought to how a statutory basis for the bodies can be secured in the Bill, so that they can act genuinely independently of health authorities when giving their advice to the authorities about the priorities for the local health economy. Without that, the patients forums that are independently based in statute will perhaps not have enough confidence that they should have in a body to which they will be obliged to provide information. I hope that the Minister will not only give us some reassurances on this matter, but will say how a statutory base could be provided.

Philip Hammond: I have just a brief comment in support of what the hon. Member for Sutton and Cheam said. We have already discussed the issue of independent local advisory forums, and it seems anomalous that they are not provided for in the Bill. May I ask the Minister a specific question? If they are to be established using the Secretary of State's powers of direction, is he then going to have to use his powers of direction, or regulation making, again, to require health authorities and trusts to provide information to them? It is not simply a question of directing that they be created, or creating them, it a question of creating the web of reporting requirements and answerability that, in the case of CHCs, is provided for because of their statutory basis. In seeking to avoid one small extra clause in the Bill, is not the Minister creating quite a complex requirement for secondary legislation and directions, in order to ensure that the ILAFs can get access, as of right, to all the information that they need, and can require health authorities and other bodies to provide them with essential data and essential access?

John Denham: On the latter point, the hon. Gentleman is quite right to mention that the Secretary of State has a range of powers to ensure that the information is provided. The very existence of those powers is the biggest reason why he would not need to use them all in the explicit way that the hon. Gentleman has suggested. The powers are there, if they are needed.
 It is a debateable point whether the advisory forums would be significantly stronger if the whole plan of structure and constitution regulations had been put in the Bill. Given the function of the ILAFs as an advisory forum for the health authority, the Secretary of State's power of direction, the ability that we have to ensure that the patients forums are representatives within the advisory forums and our keenness to allow the sort of flexibility that can deal with the problem—identified by the hon. Member for Sutton and Cheam—of health authorities wishing to approach this role in different ways, we have preferred not to put it on the face of the Bill. I agree that this is a debateable point, but I do not believe that anything is lost by doing it through directions from the Secretary of State, and that will be proven to be the case in years to come.

Philip Hammond: At the beginning of his remarks, the Minister said that the existence of these powers of direction that the Secretary of State has makes it very unlikely that he will ever have to use them. That was a welcome recognition from the Minister, and I hope that he will reflect on it, and it is precisely the point that Opposition Members have been trying to make throughout our proceedings. Where the Secretary of State takes powers as reserved powers, he effectively hangs a sword of Damocles over the organisations that are threatened by them. The Minister has acknowledged that, where the Secretary of State has reserved powers, he probably will never have to use them, because the mere threat of those being used is enough to ensure that the whole organisation, the whole NHS, runs in the way that the Secretary of State wants. That is not as a result of transparency, of over-regulation or directions given, but merely because the organisation is required to interpret the drift of Whitehall thinking, knowing that the Secretary of State has those significant reserve powers available to him. What the Minister has said is a significant comment on the whole architecture of this Bill.

John Denham: Let me make it quite clear that none of the powers to make information available are powers that have been taken by this Government, they are ones that were enjoyed by previous Secretaries of State. The hon. Gentleman's point is therefore somewhat fatuous, unless he can explain why previous Conservative Secretaries of State did not give up those powers. I am sure that he would not want to get into that.

Philip Hammond: Without wanting to take up the Committee's time, let me say that the Minister knows that my hon. Friend the Member for Woodspring has expressed the view that, were he to occupy the job that he covets—Secretary of State for Health—he would seek to reduce the power of that office, recognising something of the point that the Minister just made. The powers to which I refer are those that the Government are giving to the Secretary of State in this Bill. Those powers appear to give the Secretary of State dramatic rights to intervene in the running of trusts and health authorities. The Minister soothed the Committee by saying that those rights would be exercised only in extreme cases. He has just explained that the mere existence of those rights is enough to ensure that the will of the Secretary of State will be done throughout his empire.

Paul Burstow: The hon. Gentleman is clearly not persuaded by the argument, and unfortunately, the Minister is not yet persuaded, except that he has accepted that it is still debateable. Perhaps we can work on that and persuade the Minister of our case in due course. He did not address the question that I asked about provision of information about lines of accountability and so on. Does such a chart exist yet? Has one been drawn? It would be useful to see it. If there is one, when will it be published?

John Denham: It is not a map of the universe. Patients forums relate to trusts; local government has a scrutiny function; ILAFs help shape the health authority's direction; the independent advocacy service supports those patients who cannot be helped through the PAL system. The idea that it is a cat's cradle of accountability is not the way the system works. The functions have been identified clearly. It is then necessary to make sure that adequate liaison takes place, at the right points, between the different elements. I am not sure what kind of chart the hon. Gentleman means, but it betrays his lack of understanding of the proposals.

Paul Burstow: I do not know whether it is a lack of understanding or a desire to understand what the Government are introducing. As the Committee has progressed, it has become more and more apparent that the Government do not have a clear idea of how the arrangements will fit together. I understand that, given the nature of the Committee, the Minister cannot give us a PowerPoint presentation of such aspects. Painting pictures as the Minister has just done makes it difficult to grasp what is the interface between such bodies. Surely it is not beyond the wit of the Department to provide a simple organisation chart, so that we can see how the different bodies work together.
 I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn.

Philip Hammond: I beg to move amendment No. 253, in page 9, line 25, at end add—
 `(3) A report prepared under this section shall be published in such form as the Secretary of State shall direct within 28 days of the date on which it is submitted to him.'.
 The amendment would require the publication by the Secretary of State of a patients forum annual report. Currently, the Bill provides that the report will be delivered to the Secretary of State. We merely seek an assurance that it will be placed in the public domain. If the Minister can give that assurance, I shall be delighted to withdraw the amendment.

John Denham: It will be in the public domain.

Philip Hammond: I am grateful to the Minister. It is a shame that that is not stated in the Bill, but I accept what he has said. In those circumstances, I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Clause 12 ordered to stand part of the Bill.

Clause 13 - Patients Forums: Supplementary

Philip Hammond: I beg to move amendment No. 255, in page 9, line 26, at beginning insert—
 `( ) The Secretary of State shall by regulations make provision for—
(a) the funding of Patients' Forums and the provision of premises, other facilities and staff; and
(b) the payment of travelling and other allowances to members of a Patients' Forum or of a committee of a Forum (including attendance allowances or compensation for loss of remunerative time)'.

David Madel: With this it will be convenient to take the following amendments: No. 87, in page 9, line 26, leave out `may' and insert `shall'.
 No. 56, in page 9, line 26, leave out 
`by regulations make further provision' 
and insert 
`issue guidance to local authorities'. 
No. 57, in page 9, line 28, leave out from `The' to end and insert `guidance may include—'. 
 No. 89, in page 9, line 28, leave out `may' and insert `shall'. 
 No. 256, in page 9, line 39, leave out from beginning to end of line 4 on page 10. 
 No. 58, in page 9, leave out lines 39 and 40. 
 No. 59, in page 10, leave out lines 1 to 7. 
 No. 61, in page 10, line 12, at end insert— 
 `(2A) The Secretary of State may by regulation make provision for— 
 (a) the funding of Patients' Forums and the provision of premises, other facilities and staff; 
 (b) the payment of travelling and other allowances to members of a Patients' Forum or of a committee of a Forum (including attendance allowances or compensation for loss of remunerative time); 
 (c) the provision of information to a Patients' Forum by the trust for which it is established, including descriptions of information which are or are not to be provided.'.

Philip Hammond: I want to speak to amendment No. 255 and the consequential amendment. The amendment would simply change the geometry of clause 13 to make it clear that the regulations relating to funding for patients forums and the payment of allowance to members of those bodies are in a different category and must be dealt with differently from other issues such as the procedures that the bodies follow in their deliberations.
 The main concern that has been expressed about the bodies that the Government are putting in place relates to their independence. We all know that he who pays the piper tends to call the tune. Therefore, there is great concern to ensure that the bodies are funded on a proper basis. To that end, we have tabled amendment No. 255, which says that the Secretary of State shall, rather than may, by regulations, make provisions in relation to the funding and the payment of allowances. 
 That will not be an option for the Secretary of State. He will have to do it. As the Bill is currently drafted, he may then make other regulations in relation to the operation of patients forums. I am looking for an acknowledgment from the Minister that, because of the sensitivities about independence, there is a qualitative difference between the regulations about funding, allowances and payment to members and the other issues that will properly be dealt with by regulations as and when the Secretary of State deems it appropriate.

Paul Burstow: The amendments in my name and in that of my hon. Friend the Member for Isle of Wight are intended to explore the extent to which regulation-making powers are needed and whether it would be more appropriate for the Secretary of State to have powers to issue guidance. The amendments seek to rejig the clause, so that matters that are set become matters that are dealt with solely through guidance. They include appointment of members, qualification, disqualification of membership. However, the Secretary of State should issue regulations on funding, the provision of information to a patients forum, pay and rations.
 We tabled the amendments originally because we saw them fitting in with the group of amendments that my hon. Friend tabled earlier, which would have seen the establishment of patients forums as a duty of local authorities. It is in that context that the amendments fit best. They do not fit so well in a regime that sees them as separate entities. We strongly believe that patients forums should be established on a basis that enables them to look at patients' interests and to advocate those interests locally. The patient's experience of the NHS, which is not trust based, but follows a path of care through several trusts, can thus be better taken into account. 
 The amendments aim to separate the matters on which local authorities should be given guidance from those matters on which local authorities should be given clear regulations. We believe that they offer a much better way of putting patients forums on a firm footing.

John Denham: It is probably best if I set out our intentions as succinctly as I can.
 It is an interesting point whether we should have downgraded the regulations to guidance in some areas, but we have sought to reassure hon. Members as effectively as we can that the establishment of patients forums will be independent. Regulations, which can be discussed, seem to us to be the best way of doing that. Therefore, they would include the funding of patients forums and the provision of premises, other facilities and staff. I am not sure whether I want to draw the distinction that the hon. Member for Runnymede and Weybridge requested, but at least he will be reassured that those matters will be dealt with by regulation. 
 The issue of how patients forums will be funded and staffed will obviously be important. We have clearly said that patients forums will be managerially and financially independent of the trust or primary care trust to which they relate. The funds for patients forums will be provided by the regional office of the NHS Executive, as was the case with CHCs. As with the CHC, the patients forum, an unincorporated body, will need a host for its funds and accounts. That role could be taken on by the health authority, as happens with CHCs, but as I said earlier we are considering allowing local authorities to take on that role. There are strong arguments in favour of patients forums coming together locally to share support and expert staff. Similarly, the local authority could be the employer, as the health authority is the employer for CHC staff. More work needs to be done on exploring the options, but that is one possibility. 
 We intend that members of the patients forum will receive expenses to cover travel and subsistence and loss of earnings. That is in line with members of CHCs. Of course, the patient-nominated non-executive director will receive remuneration. It is right that we set out those matters in regulations. Regulations are needed at least to allow the NHS appointments commission to appoint members of the patients forum.

Paul Burstow: The Minister has moved on from the point on which I had hoped to intervene. An issue that is raised from time to time is the historic basis of the original funding settlements for CHCs and the level of endowment of some CHCs compared to others. As a result, they are not all resourced on the same basis. What will be done to ensure equality of funding in the new system?

John Denham: That is probably an issue that should be addressed once the Bill is enacted, but we shall certainly consider how best to provide funding across the health service. I certainly acknowledge the matter.

Philip Hammond: I am grateful to the Minister for his explanation. I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

John Denham: I beg to move amendment No. 199, in page 9, line 36, at end insert
`or by a joint committee appointed with another Forum'.

David Madel: With this it will be convenient to discuss Government amendments Nos. 200 to 202.

John Denham: This is a provision that allows joint working across patient forums, which will be welcomed by the Committee.
 Amendment agreed to. 
 Amendments made: No. 200, in page 9, line 37, leave out `of a Patients' Forum' and insert `or joint committee'. 
 No. 201, in page 9, line 38, at end insert `or Forums concerned'. 
 No. 202, in page 10, line 2, after second `Forum' insert 
`or a joint committee of two or more Forums'.
 No. 203, in page 10, line 4, at end insert— 
 `(ia) the inclusion of annual accounts of a Patients' Forum in those of a Health Authority;'.—[Mr. Denham.]

Philip Hammond: I beg to move amendment No. 257, in page 10, line 13, at end insert
`represent the population in the area served by the NHS trust or Primary Care Trust for which it is established and'.

David Madel: With this it will be convenient to discuss amendment No. 93, in page 10, leave out lines 14 to 24 and insert `will comprise—
(a) at least 25 per cent. of members who are members or representatives of voluntary organisations operating in the district whose members or client group have an interest in the health service, and 
 (b) at least 25 per cent. of members being persons living in the locality or district for whom services are being provided or may in the future be provided under the 1977 Act, and 
 (c) at least 25 per cent. of members being persons who provide care for persons detailed in paragraph (b) above but who are not employed to do so by anybody in the exercise of their functions under any enactment.'.

Philip Hammond: I suspect that this will be the last group of amendments that we need to debate today. I suspect that the hon. Member for Sutton and Cheam will want to speak to amendment No. 93. Amendment No. 250 seeks to add to the list of duties of representation a general requirement that the membership of the body should represent the community that it serves. That will not replace any of the requirements provided under subsection (3) on specific representation on the patients forum, but it seeks an overarching requirement that the membership of the body should be properly representative of the population served. It is evident what I mean by that, and I hope that it is the Minister's intention. It is merely a form of words that expresses the intention without providing specific additional requirements in the Bill. I hope that the Minister will be able to accept it.

Paul Burstow: I hope that the Minister will be able to accept either amendment, because we want the Government to clarify how they intend through regulations to ensure the widest possible representation of the interests of the local population on patients forums.
 The amendment perhaps falls foul of one of the traditional lines of defence in Committee—the overly prescriptive argument. Nevertheless, it serves as an expression of what we believe to be the appropriate way forward in terms of representation on such bodies.

John Denham: We differ on this matter, and it is worth briefly rehearsing the Government's argument.

Desmond Swayne: No, it is not.

John Denham: For some people, at any rate.
 We intend that the patients forums should be representative of patients and of organisations that represent patients and carers. That is not, strictly speaking, the same as having people who are simply representative of the local community. A difference in philosophical outlook may be involved here, but we see the advisory forum as the place where the whole local community is represented. We are keen that patients forums should represent patients relating to the trust concerned and to the services that are being provided. The issue may divide the Committee, but that is the Government's view.

Philip Hammond: I hear what the Minister says. We are still concerned that the bodies should represent the communities that they serve, but the amendment was intended merely to probe the Government's thinking and would add nothing specific to the Bill. I am happy to reflect on the Minister's remarks, and I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Amendment made: No. 204, in page 10, line 24, at end insert— 
 `(3A) The regulations may include provision applying, or corresponding to, any provision of Part VA of the Local Government Act 1972 (access to meetings and documents), with or without modifications.'.—[Mr. Denham.]

Peter Brand: I beg to move amendment No. 30, in page 10, line 24, at end insert—
 `(3A) The regulations must make provision to ensure that the members and the staff of a Patients' Forum are not financially dependent on the health authorities or trusts for which it is established.'.
 This is another attempt to make the Government reconsider having members of patients forums as executive members of trusts. I foresee that a great conflict of interest may arise. For example, it has been shown to be difficult for some directors of public health, who are also governed by their corporate duty as the director of a trust or a health authority, to be totally independent in their views. It would be nonsensical if two members of a patients forum were to attend a trust board on which one of them is a trust board member who has to take an opposite line from the representative participating non-voting member of the forum. That could be untangled by stipulating that no one should be paid by two masters, and that it would be wrong for someone who is paid by a trust to be a member of a patients forum. 
 If the Minister can assure me that he does not intend a non-executive member to be a member of a patients forum, but to be an appointment by the forum, my anxieties will be much assuaged.

John Denham: It is certainly possible that the non-executive director chosen by the patients forum would be a member of the patients forum. There are superficial attractions in the idea that the board member is a delegate from the forum, as opposed to a corporate member of the trust board. However, it becomes difficult to see how the board can operate corporately in practice, and what different legal and fiduciary duties will fall on different members of the board in those different circumstances. It is hard to see a way through that to produce the delegate type of structure. It is for that reason that we envisage them being full members of the board.
 It should be widely recognised as a significant step forward that there will be, for the first time, a route to a trust board, through a patient-focused organisation. That has never happened before. It may not solve all the problems, but it is part of an important pattern of patient representation that we are developing.

Doug Naysmith: Is it envisaged that the patients forum can remove a director of whom it disapproves?

John Denham: We shall clearly have to consider how those procedures work. I would not want to have a system of instant recall by the patients forum, for fear of producing problems. There will be an appointment procedure, but perhaps not necessarily the right to automatic reappointment after a term has been served.

Peter Brand: The Minister clearly recognises that there is a problem. There are two ways of solving it, one of which is to have a member of the patients forum being a voice, with rights to speak, but without taking on the corporate responsibilities of being a board member of a trust. The alternative would be to have the trust board membership set aside for a nominee chosen by the patients forum but who will not be a member of it. The Government's proposals create a difficult conflict of interest, but clearly it is not a matter that will be resolved this evening. We shall come back to it on Report, so I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Clause 13, as amended, ordered to stand part of the Bill. 
 Further consideration adjourned—[Mr. Jamieson.] 
 Adjourned accordingly at twenty-seven minutes past Seven o'clock till Thursday 1 February at half-past Nine o'clock.